TELUS Health Solutions transports electronic dental claims from dentists to the appropriate insurer for adjudication. When the claim is processed, the results are transmitted back to the dentist. Over 11 million dental claims are processed annually on our network. Learn more about our Assure Claims Network.
Assure Claims Dental - part of our multi-benefit claims management solution
We offer a complete management solution for dental claims that utilizes many of the newer features that have made our Assure Claims Drug solution so successful.
Our Assure Claims Dental solution supports auto and manual adjudication of claims, integrating the quality and anti-fraud controls our customers expect.
Features
- Simple, straightforward claims input
- Switching and transporting claims
Our solution takes into account the norms and standards in effect for the Canadian Dental Association and the Association of Dental Surgeons of Québec for the electronic transmission and processing of claims.
Outsourcing paper claims
We also offer clients the option of outsourcing paper claims. This solution is fast, accurate and user-friendly. An integral part of our core dental claims solution, it improves productivity and reduces processing time. Clients can manage this solution independently or they can mandate TELUS Health Solutions to manage it for them in whole or in part.
Flexible, thorough management features
Our plan management and plan assignment modules for dental claims offer detailed, flexible plans designed to handle insurers' needs, including plans that provide cross-benefits. Our dental insurance specialists work closely with insurers to ensure their plan designs reflect their customers' requirements.
Seamless transition of administration data
We develop mutually compatible interfaces that allow efficient, secure exchange of information from the insurers' system to our system and back to the insurer. This includes data related to members' eligibility, plan coverage and parameters as well as the history of claims for the plan.
Total access to dental fee information
Our service code management feature stores a master list of all care codes based on nomenclature from the Canadian Dental Association and takes into account particularities of codes in effect in the province of Québec. This module also manages specialists' service codes as well as dental fee guides for each province. Our customers can consult all the fee guides via our user-friendly Web interface.
Simple management of health care provider information
Our central professional registry stores all dentist-related information required to validate submissions and assign payment. Managing this function centrally saves insurers time and money.
Remote access to our claims management module
Our insurance clients can use our web interface to access our different dental claims modules.
Complete set of data extraction and reporting tools
We have developed a web-based module allowing insurers to execute various requests for every aspect of claims management, from detailed claims history to global data for statistical purposes. We also provides data extraction tools to support our customers' internal processes and applications.
Efficient adjudication process
Customizable auto-adjudication parameters
Our adjudication engine allows us to easily customize rules, norms and parameters at the insurer and plan level. We continuously study payment patterns to refine rules and maximize auto-adjudication potential and has developed an expert system to optimize this critical process.
Claims management
Our claims management feature is an advanced workflow system that efficiently queues pended claims to the resource identified as having the appropriate skills to expedite. This queuing system enables department managers to track process effectiveness and balance examiners' workloads.
Fraud prevention
Claims can be flagged as warranting additional scrutiny after adjudication, prior to payment. Flagged claims are deposited in our audit queue and examined by TELUS Health Solutions audit and quality control specialists.